Paula J. Britton

Reducing inner-city women's AIDS risk activities: a study of single, pregnant women.

Behavioral change reduces risk of HIV infection and development of AIDS. We compared 206 inner-city women who were randomly assigned to a 4-session AIDS-prevention group or to one of two controls, a health-promotion group or a no-intervention group. AIDS-prevention and health-promotion groups provided information, behavioral competency training, and social support. Only the AIDS-prevention group focused on AIDS-specific knowledge and skills. The AIDS-prevention group produced moderate, consistent increases in knowledge and safer sex behaviors in comparison with either the health-promotion or no-intervention group. Self-report and objective changes were sustained 6 months after intervention for both African-American and European-American women.

Exercise Stage of Change and Self-Efficacy in Primary Care: Implications for Intervention

Multiple chronic diseases are caused or complicated by a sedentary lifestyle. Thus, an important and challenging application of psychology in clinical settings is changing the behavior of sedentary primary care patients. This study focused on exercise stage of change and self-efficacy in a sample of adult family practice patients recruited while waiting for their scheduled physician appointment. Regarding exercise stage of change, 15% of respondents were in the Precontemplation stage, 26% in the Contemplation stage, 50% in the Preparation stage, 7% in the Action stage, and 13% in the Maintenance stage. Mean self-efficacy scores for exercise were significantly higher among respondents in the Action and Maintenance stages of change. These cross-sectional data are consistent with the hypothesis that movement through the exercise stages of change could be encouraged by clinical interventions that increase exercise self-efficacy. The identification of multiple personal opportunities for increasing exercise self-efficacy may be clinically useful in this context. Recommendations for psychologists in primary care settings in their work with physicians are offered.

Ambiguity of Monogamy as a Safer-sex Goal Among Single, Pregnant, Inner-city Women Monogamy by Whose Definition?

We examined the ambiguity of monogamy as a safer-sex goal in a sample of young, inner- city women (N = 447), of whom 58 percent were African- American and 42 percent European-American. It was our premise that women may be misperceiving and underestimating their risk due to differences in their definition and beliefs about monogamy, and thus are not changing their behavior. When compared to long-term monogamous women (self-reporting one partner in the past year), serially monogamous women (reporting two or more partners in the past year) perceived themselves at greater risk but did not report more frequent use of condoms. It is possible that a suggestion of monogamy may be subject to multiple interpretations and thus could be providing women with a false sense of safety. Risk reduction should be defined in specific behavioral terms.

Stage of Sexual Minority Identity Formation: The Impact of Shame, Internalized Homophobia, Ambivalence Over Emotional Expression, and Personal Mastery

Literature on sexual minorities has focused on characteristics regarding the developmental process of sexual identity formation, with little agreement as to underlying constructs. The present study (N = 855) used an online survey to investigate Casss (1984) theoretical model of stages of identity formation to explore shame and associated variables of internalized homophobia, ambivalence over emotional expression, and personal mastery across stages of identity development in order to clarify relationships among these variables. Findings offer partial support of Casss stage model of sexual minority identity development as a process of differential stage progression and suggest that the relationships between shame, internalized homophobia, ambivalence over emotional expression and personal mastery are significant in understanding identity stage development. Applications to psychotherapy are discussed.

Predicting Adult LGBTQ Happiness: Impact of Childhood Affirmation, Self-Compassion, and Personal Mastery

Numerous studies report childhood affirmation affects adult lesbian, gay, bisexual, transgender, and queer (LGBTQ) mental health. Mechanisms underlying this relationship, however, are unclear. Using attachment theory, this study explored relationships among childhood warmth and safeness, self-compassion, personal mastery, and subjective happiness in an adult LGBTQ sample (N = 523). Hypotheses tested contributions of continuous variables to the prediction of adult LGBTQ happiness, and whether self-compassion and personal mastery serially mediated the relationship between childhood affirmation and adult happiness. Results were confirmatory; however findings suggest the primary role of self-compassion as a mediator and that mastery contributed most to the prediction of happiness. Counseling implications are discussed.

The relationship among the transtheoretical model of behavioral change, psychological distress, and diet attitudes in obesity: Implications for primary care intervention

Obesity is prevalent but undertreated in primary care. Family practice volunteer outpatients (N=454) were administered the Stage of Change for Weight (URICA), the Brief Symptom Inventory (BSI), and the Diet Readiness Test (DRT) to assess the relationship between these variables and obesity. The body mass index (BMI) was used to classify obesity revealing 197 patients with elevated BMIs. There was no significant difference between the obese and the nonobese on any of the psychological measures. The obese reported significantly more difficulty setting diet goals and less control over their eating, ate more to emotional situations, and exercised less than the nonobese. The obese sample (46.7%) reported being in the Action stage of change for weight management. Implications for intervention in primary care include targeting attitudes (DRT) and dispelling physician attitudes that obese individuals have increased levels of psychological distress. Addressing Stage of Change for weight management can facilitate tailoring the appropriate intervention when used in concert with the DRT variables.

Exploration of psychological distress in gay, bisexual, and heterosexual Roman Catholic priests.

An online survey (N = 103) of secular/diocesan and religious Roman Catholic priests was conducted to assess contributions to psychological distress from sexual identity, stress, social support, and fear of compassion from others. Differences in psychological distress across sexual identity and role (religious, secular/diocesan) were also assessed. Results indicated psychological distress was predicted by stress, fear of compassion from others, and gay identity as compared with heterosexual identity. Gay-identified priests were significantly more distressed when compared with those heterosexually identified. Qualitative analyses revealed gay priests’ stress was related to the cognitive dissonance of current social acceptance of sexual minority identity juxtaposed with negative Church teaching, and perceived constraints to receiving compassion from others. Heterosexual and gay/bisexual priests all expressed profound satisfaction in their vocations, but with additional themes of loneliness, negative relationships with Church hierarchy, workload demands, unrealistic expectations, concern about the future, and ageing. Counseling and policy implications are discussed.

Lesbian, Gay, Bisexual, and Transgender Smokers: Correlations with External Health Control, Health Expectations, and Shame-Focused Coping Strategies

Cigarette smoking is a major health concern in the lesbian, gay, bisexual, and transgender (LGBT) community. This study explored if LGBT smoking heaviness was predicted by the cognitive strategies of external health control, health expectations, avoidant shame-focused coping, and attack self shame-focused coping. Differences were assessed across LGBT identification and nicotine dependence status. Results indicated external health control significantly predicted heaviness of smoking over and above age and education. Shame-focused coping strategies correlated to heaviness of smoking, external health control, and health expectations. Transgender identity associated to earlier smoking initiation compared to lesbians and gay men. Implications for clinicians and researchers are presented.

Self-Regulation Mediates LGBTQQ Oppressive Situations and Psychological Distress: Implications for Psychotherapy

There is considerable evidence that oppressive situations are associated with negative mental health outcomes for lesbian, gay, bisexual, transgender, queer and questioning (LGBTQQ) people. However, not all LGBTQQ people will develop symptoms of psychological distress. Because of the importance of discerning contributing factors to the relationship between oppressive situations and psychological distress, the authors investigated whether self-regulation mediated or moderated relations between felt danger to safety, verbal harassment and intimidation, and psychological distress. Results indicated a relationship between LGBTQQ minority stress and negative mental health outcomes, and support the importance of self-regulatory processes influencing sexual and gender minority persons’ capacities to manage environmental stressors of stigmatization and social threat. Implications for psychotherapy practice are presented.

LGBTQ Aging: Mental Health at Midlife and Older Adulthood

Abstract Premised upon strength-based models of lesbian, gay, bisexual, transgender, questioning/queer (LGBTQ) aging, this Internet study explored relationships among mental and physical health, financial anxiety, body shame, alienation, loneliness, self-compassion, and self-transcendence in midlife and older adulthood. Findings suggest LGBTQ midlife mental health is predicted by financial anxiety, physical health, self-compassion, alienation, self-transcendence, and body shame (R² =.61), and self-compassion, physical health, financial anxiety, and self-transcendence in older adulthood (R² =.56). Older adults identifying as LGBTQ evidenced less body shame and financial anxiety, and higher self-compassion and mental health. Findings suggest the primacy of self-compassion in LGBTQ developmental gerontology. Counseling implications are discussed.